Technovigilance: Intelligent Use of Electronic Data

„Technovigilance“ can help to save lives: Electronic data routinely gathered in hospitals can be used as a warning system for missed doses of prescribed medicine and making improvements to patient safety, says a new study.

A team from the Universities of Leicester and Birmingham found that the secondary use of data from an electronic prescribing and decision support system in an English hospital led to a 'substantial and sustained' reduction in rates of missed or delayed doses of medicines. The study looked at how using the electronic system combined with organizational efforts helped to address a major patient safety threat.

Roughly one in five patients in National Health Service (NHS) hospitals miss a dose of prescribed medication or get it late. The National Patient Safety Agency has shown that omitted or delayed doses of essential drugs are a major problem, responsible for 27 deaths, 68 severe injuries and 21,283 patient safety incidents between 2006 and 2009 in the UK. But effective solutions for monitoring and reducing the problem have been hard to find. The electronic system in the study hospital could be programmed to trigger a series of emails if, for example, a patient missed more than two doses of antibiotics. If no action was taken, these emails was be escalated upward, from ward nurse through the layers of the hospital, eventually to chief executive.

Mary Dixon-Woods, Professor of Medical Sociology at the University of Leicester Department of Health Sciences, says: "This is one element of what we call 'technovigilance' – turning data into intelligence which can then be put into effective action. Other elements include using the electronic system to find examples of where care did not seem to meet the required standards, and holding high-level care omissions meetings with staff on clinical areas to find out what happened". 'Technovigilance' was credited with a fall in the rate of missed doses from 12% to 5%.

The study found that these preventative actions included fixing organizational systems – such as delivery of medicines to specific locations – as well as emphasizing the personal responsibility of individual staff. The hospital's executive team credited technovigilance with a major "cultural shift" in staff attitudes towards administering medicines on time.

Dixon-Woods commented: "One danger was that staff were so busy doing things that were going to be electronically monitored by the system that they did not have time to do other equally valuable things – such as talking to patients. We also identified concerns that the way the system was set up meant that nurses' behavior was subject to much more surveillance than others."

The model of technovigilance is now being optimized in light of findings from the study. The researchers stress that using alternative and complementary forms of intelligence, including evidence of patients' experience and executive visits to clinical areas, may be important in countering the distorting effects of technovigilance and allowing a more complete picture of the quality and safety of patient care to emerge.